Continuation ECT as Good, or Poor, as Drug Therapy for Preventing Depression Relapse

Dec 6 2006
Reuters Health Information
NEW YORK (Reuters Health) Dec 06 – Electroconvulsive therapy (ECT) is comparable to pharmacologic treatment in preventing relapse of depression, but both approaches have limited efficacy, investigators report in the December Archives of General Psychiatry.
While electroconvulsive therapy is extremely effective for acute treatment of major depression, ECT is also being used as continuation or maintenance treatment (C-ECT) to prevent relapse. However, there are few data to support such use, note Dr. Charles H. Kellner and colleagues at five different academic clinical centers.
Dr. Kellner, from the UMDNJ New Jersey Medical School in Newark, and members of the CORE group (Consortium for Research in ECT) conducted a two-phase trial with 531 patients with primary major depressive disorder.
The first phase involved a course of bilateral ECT delivered three times per week for all the subjects until their illness went into remission. Participants who maintained remission at 1 week were then randomly assigned in the second phase to continuation ECT or a combination of nortriptyline and lithium.
ECT was administered weekly for 4 weeks, every other week for 8 weeks, and monthly for 2 months.
Relapse rates were 37.1% for C-ECT and 31.6% for medication treatment. In the two arms, 46.1% and 46.3% remained in remission, respectively, while 16.8% and 22.1% dropped out.
Subjects in both groups who remained in remission showed similarly improved cognitive abilities during the course of the trial, as assessed by the modified MMSE.
“An important interpretation of these data is that relapse or treatment discontinuation rates after successful ECT remain unacceptably high with standard treatment regimens,” Dr. Kellner and his team write, although they acknowledge that both types of treatment were “modestly effective in preventing depressive relapse.”
However, they caution that failure to detect significant differences between groups “cannot be taken to mean that the outcomes in the two groups are equal.” Instead, their advice is to decide treatment options “based on judgments about tolerability for the individual patient and patient preference.”
They hope that further research will turn up biomarkers to predict which patients will respond better to one or the other treatment. They also suggest that better remission rates might be achieved by combining C-ECT and medication therapy.
Arch Gen Psychiatry 2006;63:1337-1344.

Depressed OAP died after electric shock treatment

Dec 7 2006

By Gemma Collins
Berkshire Co UK

A FRAIL pensioner who battled with manic depression for 60 years, died after undergoing electric shock therapy at Reading’s Prospect Park Hospital.

Violet Dixon, 81, who suffered from Bipolar affective disorder was given Electroconvulsive Therapy after becoming so depressed and run down that staff feared she would die.

Mrs Dixon who lived with husband Victor in Compton near Newbury had been suffering from anxiety and depression since the 1940s and in the last three years had received several ECT treatments – which involves passing an electric charge through electrodes on her head to provoke a fit or a seizure.

A Reading inquest heard that in February, while sectioned under the Mental Health Act, Prospect Park staff felt she needed electric shock treatment because she was not responding to medication.

But after a second treatment, Mrs Dixon started vomiting, despite being anaesthetised and not having eaten for 24 hours.

She was rushed to the Royal Berkshire Hospital with Aspiration Pneumonia – caused by inhaling vomit – but died there the next day.

The post-mortem revealed that, unknown to her doctor at Prospect Park Hospital, Mrs Dixon had been suffering from an inflamed gall bladder.

Royal Berks anaesthetist Dr Gillian Harrison, who put Mrs Dixon under before her ECT, said: “These patients are mentally ill and often have other medical problems which are very difficult to tell when they won’t give you any history because they are so ill, and they won’t be compliant to medical tests.

“Mrs Dixon had been carefully examined, it was totally unexpected that she had bowel obstruction.”

Berkshire coroner Peter Bedford, recording a ‘narrative verdict’, said Mrs Dixon had undergone many previous ECT treatments without adverse effects.

He said gall stones had caused an undiagnosed gall bladder infection, and added: “This had caused an obstruction which led to severe gastric delay and in turn led to the sequence of events causing her death.”

Season of Suppers

Meals on Wheels Association of America (MOWAA) and Banfield, The Pet Hospital have teamed up to provide meals for pets this holiday season. The campaign is called Season of Suppers.

After discovering that countless senior recipients of Meals On Wheels were feeding their food to their pets, MOWAA created We All Love Our Pets (WALOP), a new initiative that seeks to unite Meals On Wheels programs across the country that are providing pet food.

It’s EASY to donate! Go to any Banfield or Meals on Wheels office and drop off your donation, either pet food or monetary. I shop at PetSmart, and there’s a Banfield inside. They’ve made it easy – there’s a box right there, and I bought extra food – dog and cat – and dropped it in. I plan to continue….it’s easy and every little bit helps a dog or cat and owner. Your food donation stays in your own county, for area MOW recipients.

I’m a believer in the power of pets to help people emotionally and health-wise. Health professionals are beginning to realize the power of pets as well, and are bringing pets into nursing homes and hospital rooms to visit. IT HELPS!

What a FABULOUS program this is. My thanks go out to MOWAA and Banfield for their efforts, and I ask that you give as much as you possibly can. Even one can or box of food will help feed a pet.

Bringing pets and people together – and finding ways to help – has always been a “pet” cause of mine. It helps the individual who gets unconditional love, and it saves another life of a dog or cat that otherwise might not find a home. It’s a win-win for all!

Meals on Wheels provides hot meals for elderly and persons with disabilities. I have a special fondness for them because as my grandmother became older, she found it hard to cook a healthy meal. Meals on Wheels brought her healthy, hot meals. What’s more, my grandmother, a farm woman, always loved her pets. Cats especially. She was lucky enough to be able to afford food for her cats, but many are not so blessed.

So while you’re out doing your errands and holiday shopping, stop by your local Banfield and drop off a donation of food or money! It’s a Season of Suppers and you can help. Thank you for your generosity!

Visit Banfield, The Pet Hospital
Visit Meals on Wheels


Who are those pets in the banner pictures?

The elderly woman and dog picture comes from MOWAA. The rest of the pets are mine. The dog is Sharik, who passed away several years ago. (Sharik means little ball in Russian, and Sharik is the most common dog name in Russian. But I named her after the hero of my favorite book, Heart of a Dog by Bulgakov.) She was a golden retriever/chow mix whose mother was a stray that found shelter in my uncle’s barn. I hope to see her again at the Rainbow Bridge one day. I miss her terribly.

The black cat is Dmitri, who died one year ago. I got him as a kitten from the vet, who had some babies who needed homes. He was 16 when he died and lived a generous life. He never met a person, dog or cat he didn’t like. He had the ability to turn every dog he met into a friend. I credit that gift to Sharik, who raised him from a kitten. They had a very special relationship. I miss him so much, and so does Jack.

Jack is the gray cat and he came from Seattle. He’s the Internet cat and loved by so many around the world. His owner, Catharine, was dying of breast cancer. She had adopted him from a Seattle shelter, where he’d been in a feral colony. She worried that he would be dumped when she died, so she reached out to people in a cat health discussion group to find Jack a home. Long, wonderful story of Netizen generosity short – Jack made his way to me on the pet bus. You can read Jack and Dmitri’s love story here.

He and Dmitri had some beautiful years together and became joined at the hip. When Dmitri died, Jack became so grief stricken and horribly depressed. Two weeks later, I went to PetSmart for food and they were having an adoption day.

I’ve always felt that Dmitri was there guiding me that day, telling me to bring that deaf little girl home. And I did. That’s the white cat, Jasmine. She’s special with her disability, but we’ve learned some sign language and she brought Jack out of his despair. She did the same for me, and she’s a funny little cat. She likes to dunk her toy mice in the toilet and drown them. She also likes to “hide” in paper bags and attack everyone. We all (including Jack) pretend to be surprised. She doesn’t know that she makes a lot of noise in her bag, so she hides, then jumps out and boxes feet. She squeals with joy and runs back into her bag.

Nobody wanted Jasmine because she had a disability, but that made her special.

So please, please give what you can to this wonderful program. And you can find a list of other pet charities that I support on my links page.

Thanks for reading! And thanks for giving.

Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression

Archives of General Psychiatry
Dec 2006

A Multisite Study From the Consortium for Research in Electroconvulsive Therapy (CORE)

Charles H. Kellner, MD; Rebecca G. Knapp, PhD; Georgios Petrides, MD; Teresa A. Rummans, MD; Mustafa M. Husain, MD; Keith Rasmussen, MD; Martina Mueller, PhD; Hilary J. Bernstein, DHA; Kevin O’Connor, MD; Glenn Smith, PhD; Melanie Biggs, PhD; Samuel H. Bailine, MD; Chitra Malur, MD; Eunsil Yim, MS; Shawn McClintock, MS; Shirlene Sampson, MD; Max Fink, MD

Arch Gen Psychiatry. 2006;63:1337-1344.

Background  Although electroconvulsive therapy (ECT) has been shown to be extremely effective for the acute treatment of major depression, it has never been systematically assessed as a strategy for relapse prevention.

Objective  To evaluate the comparative efficacy of continuation ECT (C-ECT) and the combination of lithium carbonate plus nortriptyline hydrochloride (C-Pharm) in the prevention of depressive relapse.

Design  Multisite, randomized, parallel design, 6-month trial performed from 1997 to 2004.

Setting  Five academic medical centers and their outpatient psychiatry clinics.

Patients  Two hundred one patients with Structured Clinical Interview for DSM-IV–diagnosed unipolar depression who had remitted with a course of bilateral ECT.

Interventions  Random assignment to 2 treatment groups receiving either C-ECT (10 treatments) or C-Pharm for 6 months.

Main Outcome Measure  Relapse of depression, compared between the C-ECT and C-Pharm groups.

Results  In the C-ECT group, 37.1% experienced disease relapse, 46.1% continued to have disease remission at the study end, and 16.8% dropped out of the study. In the C-Pharm group, 31.6% experienced disease relapse, 46.3% continued to have disease remission, and 22.1% dropped out of the study. Both Kaplan-Meier and Cox proportional hazards regression analyses indicated no statistically significant differences in overall survival curves and time to relapse for the groups. Mean ± SD time to relapse for the C-ECT group was 9.1 ± 7.0 weeks compared with 6.7 ± 4.6 weeks for the C-Pharm group (P = .13). Both groups had relapse proportions significantly lower than a historical placebo control from a similarly designed study.

Conclusions  Both C-ECT and C-Pharm were shown to be superior to a historical placebo control, but both had limited efficacy, with more than half of patients either experiencing disease relapse or dropping out of the study. Even more effective strategies for relapse prevention in mood disorders are urgently needed.

Author Affiliations: Department of Psychiatry, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (Drs Kellner, Petrides, and O’Connor); Departments of Psychiatry and Behavioral Sciences (Dr Kellner) and Biostatistics, Bioinformatics, and Epidemiology (Drs Knapp and Mueller and Mss Bernstein and Yim), Medical University of South Carolina, Charleston; Department of Psychiatry, The Zucker Hillside Hospital, North Shore–Long Island Health System, Glen Oaks, NY (Drs Petrides, Bailine, Malur, and Fink); Department of Psychiatry and Psychology, Mayo Foundation, Rochester, Minn (Drs Rummans, Rasmussen, Smith, and Sampson); and Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas (Drs Husain and Biggs and Mr McClintock).

Master of the Dark Arts

Ignored for decades, the twisted genius of Mervyn Peake is finally getting the attention it deserves

Dec 11, 2006

With a career encompassing 25 years that included five novels, a handful of plays and thousands of drawings, paintings and sketches, why isn’t Mervyn Peake a more celebrated English literary and artistic hero? A cult figure today, Peake is best known for Gormenghast, his bleak but compelling gothic fantasy trilogy published in the 1940s and ’50s about the hierarchy of a fictional castle, Gormenghast, and the Machiavellian machinations of its inhabitants. But he was also an accomplished illustrator, painter and war artist. “If somebody’s good at everything, then they’re never taken seriously, are they?” muses Chris Beetles, owner of the eponymous gallery in St. James’ in London that hosted a rare exhibition of Peake’s art in October.

It is precisely this failure to acknowledge Peake’s breadth of talent that Mervyn Peake: The Man and His Art, a new and comprehensive guide to his career, seeks to redress. In 1998, Peake’s son Sebastian met Alison Eldred, an avid collector of Peake’s artworks at Beetles’ gallery, and over dinner the new acquaintances decided to compile and edit a book which, says Sebastian, would show his father’s “eclecticism and breadth to a new generation.”

Though Peake’s talent is indisputable, the source of his marvelously twisted imagination is elusive. Unlike the early years of many masters of the macabre, Peake’s childhood was happy and contented. The son of a doctor with the London Missionary Society, Peake was born in Kuling, China, in 1911 and lived there until he was 11 years old. As a boy, he learned 600 basic Mandarin characters from a Chinese calligrapher, causing later observers to remark on the strange way he held his pen. After his family returned to England, Peake finished his education at Croydon School of Art and the Royal Academy Schools.

Early in his career, Peake became a documentary war artist during World War II. This experience appears to have pushed his world view and his art into a considerably darker realm. In June 1945, he was among the first British civilians to visit the liberated concentration camp at Belsen, Germany. Most of the former prisoners he saw there were too sick to be evacuated. The stark poems and drawings he made about these victims literally dying before his eyes are nearly too harrowing to bear. Returning to Britain, he finished the first Gormenghast book in 1946 and spent the next 20 years as a writer and illustrator, contributing art to the tales of the Brothers Grimm, Treasure Island and Dr. Jekyll & Mr. Hyde.

While his style is similar to American contemporary Edward Gorey, Peake’s bizarre sensibilities were less cruel. He enjoyed great critical acclaim as an artist during his career — he was commissioned by the Queen Mother to do illustrations for her grandson Prince Charles’ nursery in the 1950s — but he was largely ignored by the literary observers of the time. Kingsley Amis once called Peake “a bad fantasy writer of maverick status.”

This book shows just how wrong Amis and his cohorts were. The heavily illustrated tome punctuates examples of Peake’s art and excerpts of his writing with purely biographical chapters. Cartoonist Chris Riddell of the Observer Sunday newspaper, Lord of the Rings illustrator John Howe, and others who have been influenced by Peake contribute a range of essays and analysis as well.

Fantasy and science fiction author Michael Moorcock, who contributes an introduction to the book, says: “Peake is in the great tradition of idiosyncratic English writers. His poetry and fiction, like theirs is sui generis and, like his drawing and painting, reveals authentic genius.” Comic-book writer Alan ( Watchmen, Lost Girls) Moore calls Peake “probably one of the finest writers in the English language,” but says literary snobbery that considers fantasy a lesser art form has contributed to his neglect.

Already at an ebb in his career, Peake developed Parkinson’s disease in 1956. Despite attempts to improve his health with electroconvulsive therapy — in which high-voltage electricity is passed through the brain — he died in 1968 at the age of 57. His wife Maeve Gilmore, almost destitute after he died, went to the Tate Gallery to sell her husband’s body of work. She was offered £1,500 for the complete collection. Disgusted, she stormed out. If there is any justice, Mervyn Peake: The Man and His Art may well ensure that such snubs are not repeated.

Lou Reed: ‘I don’t believe in dressing up reality’

‘I don’t believe in dressing up reality’

Bernard Zuel
December 8, 2006
Syndey Morning Herald

To understand Lou Reed you could begin where he began: the works of American poet and author Delmore Schwartz and the novels of proto-grunge writer Hubert Selby jnr, author of Last Exit To Brooklyn and Requiem For A Dream.

By the time the Long Island-raised Reed met him at Syracuse University in the early 1960s, Schwartz was in the last years of his life and showing the effects of alcohol and drug abuse. He befriended the young English student, encouraging him to write naturally, to use the vernacular, a lesson that left its lasting mark via his early book, In Dreams Begin Responsibilities. Reed was to say later: “I read that in college and it changed my life forever. One of the greatest short stories ever written, five pages and not one polysyllabic word.”

At the same time Reed was developing a strong response to the realism of Selby’s portrayals of the American demi-monde, the hookers, hop-heads, the damaged war veterans. These weren’t imagined people, no matter what shocked critics and the comfortable middle class said. The effect was immense on Reed, who in his teens had been subjected to electroconvulsive therapy, ordered by his parents, who were disturbed by his developing homosexuality.

As he was to later say of his writing: “The idea behind it was to try and bring a novelist’s eye to it and, within the framework of rock and roll, to try to have that lyric there so somebody who enjoys being engaged on that level could have that and have the rock and roll, too – I don’t believe in dressing up reality. I don’t believe in using make-up to make things look smoother.”

When Reed began writing songs upon moving to New York in 1963, the material he wrote at the publishing house Pickwick Records was in stark contrast to the material he wrote at home. The private songs included Heroin and Waiting For The Man, two songs about the pleasures and deprivations of a drug user, later to appear on the albums of his group the Velvet Underground. Later, there would be songs about the transvestites and experimental artists who shared his downtown neighbourhood, songs about the prostitutes and underage runaways who were beaten at home and on the streets, songs about crippled relationships and weak human beings.

Welsh avant-garde musician John Cale, who met Reed at Pickwick where their almost instant bond led them to form the Velvets, said Reed’s songs weren’t necessarily autobiographical but “they gained their strength from first-person reportage”. Or, to steal a line from a Velvets song, “I’ll be your mirror/Reflect what you are, in case you don’t know”.

Suffering and degradation had long been staples of the blues, but it was rare in pop and rock. In the late ’60s, when the Velvets first played in San Francisco, their grimy, sometimes vicious tales were in sharp opposition to the hippie scene developing there and in London.

In the 1970s, as Reed’s solo career began, the lyrical and musical signposts were as jarring. In an interview with artist Julian Schnabel, who has designed the Berlin show coming to the Sydney Festival: “I’ve always been interested in emotion and transcendence – where do these things come from and what do you do with them when you have them?”

Even when Reed was aligned with the glam rock scene, hanging out with David Bowie, who produced his most successful solo album, Transformer, and sporting the androgynous look, he stood out. Rather than camp, there was about him the threat of the street tough giving off the “waves of fear” he sang about.

Musically, too, Reed wasn’t easily quantifiable by ordinary standards. From the start he’d noted and applied the assaulting noise and harsh, free jazz shapes of Pharaoh Saunders and Ornette Coleman. It was there in the sonic pummelling of the second Velvets album, White Light White Heat, and taken to extremes in 1975′s feedback-loaded Metal Machine Music. But he was just as capable of songs of almost ephemeral delicacy, such as Pale Blue Eyes , and haunting sadness, as in much of Berlin.

His career has been inconsistent and dotted with at most two dozen great songs, but Reed has rarely failed to provoke a response. “My primary thing has always been to spark an emotion in the listener that they might not be prepared for,” Reed said a few years ago. He has succeeded more often than most.

The Comeback of Electroshock Therapy

Nebraska TV
Thursday 12/07/06

Electroshock Therapy, now called Electroconvulsive Therapy or ECT, a surge of electricity to the brain, is still being used to treat severe depression. NTV talked to one patient who says he wouldn’t be alive today if it wasn’t for this controversial treatment.

“After my third suicide attempt, they mentioned ECT. It almost sounded like a last line of defense, said Kevin Karmazin, an ECT patient.

Kevin’s depression was serious. He was already on a cocktail of anti-depressants that wasn’t working.

“When I was manic I was out of control. I couldn’t sit still. I spent a lot of money and would often stay up for days in a row,” said Karmazin.

He says the pills created many adverse side effects.

“They just threw all this medicine at me. You didn’t know what side effect was caused by which pill,” said Karmazin.

But all that changed when he went through ECT.

“I was super nervous. But the next thing I remember, I’m waking up, and I’m like, ‘Are we done already?’ said Karmazin. “I felt refreshed and rejuvenated afterward … It’s been an all-good experience for me.”

Although Kevin has experienced some memory loss, a side-effect of ECT, he says it is worth it.

“If I would have known how much it would help me, I would have done it a long time ago,” said Karmazin.

Kevin’s story is not unique. Doctors are now saying that anti-depressants may not be as effective for serious depression. Patients may want to consider ECT.

“Any medication, the data shows, is not quite as good as ECT,” said Dr. Jasung Kim, a Psychiatrist M.D. at Bryan LGH Medical Center in Lincoln.

In fact, Kim says ECT may work better than traditional methods.

“It’s a more potent way to stimulate the brain, period. No medication can compete with ECT, that’s reality,” said Dr. Kim.

“I thank God they thought of doing this to me. I don’t know what else they could have done.”

It’s important to note that ECT is not right for everybody. Doctors say it is used as a last resort for serious depression. Some doctors will not even consider ECT, saying it is too invasive.

Depression: Ten Self-Care Strategies

Toronto Daily News
Dec 7 2006

There’s no quick fix for depression. Even if you are under medical care and taking antidepressant medication, improvement takes time.

There’s no quick fix for depression. Even if you are under medical care and taking antidepressant medication, improvement takes time.

The December issue of Mayo Clinic Women’s HealthSource offers five self-care strategies that can help you feel better and reduce the risk of recurrence.

1. Keep active. As little as 15 to 30 minutes of physical activity most days has been shown to improve mood. Long-term regular exercise can help prevent recurrence.

2. Eat well. A well-balanced eating strategy will help you feel better now and later as you battle depression.

• Eat more whole grains, beans and vegetables. They provide a longer-lasting energy source than processed baked goods and sugar.

• Eat regular meals, especially breakfast. Regular meals avoid the irritability and overeating that can come from skipping meals. Both can lead to worsening of depression.

• Increase your intake of cold-water fish such as salmon, halibut, tuna and bluefish. Research indicates that the omega-3 fatty acids in these cold-water fish may help reduce symptoms of depression.

• Avoid alcohol and caffeine, which can contribute to depression and anxiety.

3. Get adequate sleep if you feel depressed. Aim for eight hours a night, and be consistent with bedtime.

4. Control stress. Coping with depression is stressful enough, so try to limit other sources of stress.

5. If you need a break, take it, even if it’s just a day trip or weekend getaway.

6. Recognize stress signals and slow down. Is your stomach upset? Are you forgetting things or feeling extra irritable? Take notice of your signals and do something about it.

7. Stay connected. Make relationships a priority. Social ties give you a sense of purpose and meaning in life which is important when you suffer from depression.

8. Recognize the importance of give and take. It’s true you should give of yourself in a relationship, but it’s also important to receive from others, especially when you are depressed.

9. Cultivate your spirituality. Studies have shown that believing in something larger than yourself strengthens your ability to cope with depression.

10. Avoid negative and unhealthy connections that might bring you down.

A beginning to forget

A beginning to forget
Mom writes a happy ending to battle with postpartum depression

Nov 26 2006

The birth of her only child is not even a blur to Carolyn Brink.

She doesn’t remember it at all.

In fact, she doesn’t remember the first few months of Zachary’s life. She was trapped in the depths of postpartum depression, a perilous condition made even more dangerous by an adverse reaction to the drugs prescribed to help her. She recalls almost nothing from that period except this:

” I came close to not being around,” she said. “I about killed myself.”

Brink’s story has a happy ending. She survived, her baby is fine and her family is strong. More than two years later, she feels back to her old self. A family friend recently published a book about her ordeal (“Mommies Cry Too: A Painful & Triumphant Story of Postpartum Depression,” by Carol S. Harcarik); reading it, Brink said, is “like reading a story that happened to someone else.”

Brink said she is willing to put herself in the public spotlight so she can help other women who experience postpartum depression.

“I had a great family, a great life and a successful career, and I was thrown into this ridiculous tailspin,” said Brink. “People can look at me and say, ‘If it could happen to her, it could happen to me.’ But they can also say, ‘She got better, I can get better.’

“I figure if I talk about it, maybe other people can have hope.”

Brink, 31, and her husband, De- mian, 34, moved to Richmond in 2002 from Minnesota. Both wound up working for The Martin Agency. Like most first-time parents, they eagerly anticipated the birth of their son, Zachary, in May 2004. The euphoria lasted until Zachary was placed in his mother’s arms for the first time shortly after his birth.

“I had in my mind what it was going to be like when she first saw him,” said Demian. “Tears, hugs, smiling.”

However, her reaction was oddly detached and distant. “Not that overflowing emotion I’ve come to expect and love about her,” he said.

When she returned home, Carolyn was anxious and panicky and wanted little to do with Zachary. She was almost catatonic at times. She said she’d made a terrible mistake by having a baby and that maybe she and Demian should put him up for adoption. Later, she spoke of suicide.

This from a person who by her admission is an overachieving “Type A” personality who had always tried to find the positive side of life and never harbored thoughts of killing herself.

“It was a long, hard struggle,” said Mary-Jane Kitchen, Carolyn’s mother, who lived in Wisconsin but stayed with her daughter, son-in-law and grandson through much of the nightmare. “Fortunately, throughout this whole thing, she was very open and honest about her feelings, even though it was really hard to listen to what she was saying. But because she was open and honest, it was easier for me to gauge where she was and how serious it was. If she hadn’t been so honest, I don’t know . . . ”

Only a few days after Zachary’s birth, Carolyn’s mother and husband sought medical help for her. At first, the prescription was relaxation techniques and more sleep. Then came medication. Then different antidepressants. Nothing worked for long, and she was getting worse. Finally, she underwent electroconvulsive treatments, which provided slight relief but no significant improvement.

Not knowing where to turn next, her father called a physician friend at the Mayo Clinic in Rochester, Minn. She checked in in September 2004, and her life turned for the better.

Using a test that was new at the time, doctors determined her body was slow to metabolize drugs, meaning the drugs she was taking weren’t being processed quickly enough and were, in effect, poisoning her. She was prescribed different medication and began to improve. She also underwent talk therapy and was home by mid-October.

She remembers little before Mayo — her Mayo doctors believe her loss of memory is related to the electroconvulsive treatments and may be temporary but she had her life back and soon came to a most fulfilling revelation: She is a good mother.

“It took a long time” to come to that realization, Carolyn said. Now, she’s looking forward to being a mother again. She and Demian have talked about having more children, and her doctors say with proper planning and a support system in place,she should make a better postpartum adjustment.

“It would be nice,” Carolyn said of providing a sibling for Zachary, “to be there from the beginning and have memories of it.”

A Season of Suppers – Let’s help Meals on Wheels feed pets too!

Those who know me know that I’m a big believer in a better quality of life through the power of pet love, for the elderly and persons with disabilities. I’d like to ask you to consider giving to a wonderful program this holiday season, “A Season of Suppers,” which will provide pet food along with hot meals via the Meals on Wheels program.

A program like this has been on my Wish List for a long time. Wishes do sometimes come true. :)

More from Associated Press:

Nov 23 2006

FORT WORTH, Texas – When 87-year-old Lucille Mann knits, her 2 1/2-pound dog Pepper curls up beside her or nuzzles in her lap.

“I just don’t know what I’d do without her because she’s my life,” she said.

Realizing the two are inseparable, Meals On Wheels of Tarrant County not only delivers daily meals to Mann, but also drops off some pet food for her treasured Chihuahua.

About a fourth of the Fort Worth chapter’s 400 clients receive free pet food in addition to daily meals. The chapter started providing cat and dog food five years ago after volunteers noticed a growing number of clients feeding pets from their own plates.

This holiday season, the Meals On Wheels Association of America and Banfield, The Pet Hospital are teaming up to help needy seniors nationwide feed their pets.

They hope to collect 1 million pounds of critter vittles at 575 Banfield veterinary hospitals across the country during a two-month pet food drive called “A Season of Suppers.” Since the cause started earlier this month, donation boxes have been filling up quickly, so volunteers are already making deliveries.

“The holiday time is when there is a more acute awareness of people in need, especially seniors who may not have other relatives and are really more isolated than the general population,” said Sandy Campbell, president of Banfield Charitable Trust, the veterinary practice’s nonprofit organization.

Portland, Ore.-based Banfield and Meals On Wheels also are accepting monetary donations in hopes of raising $100,000 for the meal-delivery agency’s “We All Love Our Pets” program. The pet food program already helps seniors in Fort Worth, Fort Lauderdale, Fla., and Sacramento, Calif. and the agency would like to expand into other communities.

“It’s truly awesome they’re doing this,” said Janine Brown, program manager of senior nutrition services at the Sacramento County Department of Human Assistance. “Not only do seniors not have to share their food, which isn’t healthy for pets, but they can keep the limited amount of income for their medicine and electric bills.”

Elizabeth Escontrias and her brother, Manuel Valle, who live in Fort Worth, said their lives are enriched by their several cats and five small dogs, including a feisty 11-year-old Chihuahua named Bad Girl whose tongue always hangs out.

But feeding them is difficult on a fixed income, they said.

“I’d have to give them away if they (Meals On Wheels) didn’t help me,” said Escontrias, 68. “Our animals are just like family. They’re our little children.”

Meals On Wheels provides food for homebound people age 60 and older. Many are low-income, although there is no minimum income requirement.

Though the priority is providing meals to seniors — four in 10 Meals on Wheels chapters nationwide have waiting lists — the agency says the pet food program improves the quality of life for its clients.

“For most of our clients, their pet is probably the most important thing in their lives. It’s their family and the only friendly face they see,” said Enid A. Borden, CEO of Meals On Wheels Association of America. “That’s why this program is so important.”


On the Net:

Meals On Wheels Association of America:

Banfield, The Pet Hospital:

Fraud tip-offs really paid off

The Associated Press
Nov 24 2006

WASHINGTON — Whistle-blowers tipped off the government to $1.3 billion worth of fraud cases over the last year, largely at hospitals or other healthcare providers, the Justice Department said this week.

Whistle-blowers were paid $190 million over the year for alerting the government to the fraud. In all, the department recovered a record $3.1 billion in settlements from individuals and companies during the 2006 fiscal year that ended Sept. 30.

The largest settlement, worth $920 million, came against Dallas-based Tenet Healthcare Corp. Following claims from six whistle-blowers, prosecutors accused Tenet of overbilling the government for $806 million in Medicare payments and paying $49 million in kickbacks to doctors who referred patients to the chain.

Harold Sackeim reverses position in upcoming study

by Linda Andre
Director, CTIP

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

NIMH-funded research study published in the January 2007 issue of Neuropsychopharmacology

Author and primary investigator: Harold Sackeim

Funding: NIMH grants

#35636, Affective and Cognitive Consequences of ECT, funded since 1981 for a total of approximately ten million dollars so far (grant has been renewed through 2009)

#59069, ECT Practices in Community Settings—Evaluating Outcomes, funded since 1999 for a total of approximately 3.5 million dollars so far

Summary: After 25 years and millions of dollars of federal funding to research the adverse cognitive effects of ECT—25 years in which not one single longterm followup study was ever published—self-proclaimed “world expert” on ECT Harold Sackeim has now reversed his position, admitting that ECT routinely causes permanent memory loss and deficits in cognitive abilities. His new study—the first to be published in which he followed patients as long as six months, and one of his only studies to use controls—validates a generation of patient reports of permanent iatrogenic disability, and disproves Sackeim’s previously published claims that these reports were simply symptoms of mental illness. Other findings: there is no evidence that ECT increases intelligence, as Sackeim has previously claimed; and women are much more likely than men to experience severe permanent amnesia.

Significance: Harold Sackeim has been called the Pope of ECT, and for good reason. He’s published more on ECT than anyone in the world, has received more money to research it than anyone in the world, and is the author of the American Psychiatric Association’s patient information statement and consent forms, which are used by most hospitals in America. Through his writing, teaching, testimony—and positions on peer review, editorial, and funding boards, including NIMH grant review panels—he has more influence on what the profession and the public believe about ECT than anyone in the world. What Harold says goes.

Conclusion: This study could have been done at any point in the past 25 years. If it had, a generation of patients could have been warned of the likelihood of permanent significant memory and cognitive deficits before, instead of finding out after, ECT. In fact, there is evidence—from Harold’s own statements—that over the years he has in fact conducted studies following up ECT patients for a long as five years…but never published the results. Why not? Why did it take 25 years and over ten million dollars to validate what patients have been saying all along? In other words: What did Harold know, when did he know it, and why wasn’t it revealed?

Quotable quote from the study: This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

For a detailed critique, see below.

For the past 25 years, patients who received electroconvulsive therapy (ECT) have been told by the nation’s top ECT doctor that the controversial treatment doesn’t cause permanent amnesia or cognitive deficits and, in fact, improves memory and increases intelligence. Psychologist Harold Sackeim of Columbia University also taught a generation of ECT practitioners around the world that permanent amnesia is so rare it could never be studied. Sackeim was the popularizer if not originator of the position that former patients who said the treatment erased memory were simply mentally ill and thus not credible.

His newest and perhaps last ECT research study disproves his tenaciously held claims about the treatment’s harmlessness. It is, in effect a stunning self-repudiation of a 25-year research career…one in which he accepted federal research money with one hand and consulting fees from shock machine companies with the other.

See, for instance, the key finding:

This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.

Similarly, from the abstract:

Despite ongoing controversy, there has never been a large scale, prospective study of the cognitive effects of electroconvulsive therapy

Sounds like the research team is congratulating itself for being “the first,” as if they’d made a discovery before anyone else, doesn’t it? You might think that…if you didn’t know that Sackeim has held the only available NIMH research grant to study ECT’s adverse effects, titled “Affective and Cognitive Consequences of ECT,” continuously since 1981…and if you didn’t know what Sackeim promised the federal government in his original application for grant funding:

“The major objective of the proposed research is to examine the effects of bilateral and right unilateral electroconvulsive therapy on affective and cognitive functioning. The consequences of the two treatment modes will be studied in regard to neuropsychological functions that have previously not been studied…Drug-free inpatients presenting major unipolar depressive disorder will be tested before, during and after treatment and a matched normal control group will be tested at comparably spaced times.”

Instead of doing this, however, he used his grant money largely to compare different types of ECT to each other, not to examine the effects of ECT; and only less than a handful of his 200+ published studies used normal controls, an absolute necessity to isolate the effects of ECT.

Why did it take 25 years to conduct one large, long-term controlled follow-up study? And in the absence on this research, why did Harold so confidently assure professionals, patients, legislators, and the public that ECT was safe?

A closer look at the study shows us that, in fact, Harold and his team are still not being honest with us, still not revealing all they know. They tried their damnedest not to find out what ECT really does…but failed. Here they reveal only the minimum information they had to concede after using every trick in the book to bias their research in favor of not finding negative effects of ECT.

What tricks did they use here?

1) The assumption that ECT does not cause permanent amnesia and cognitive deficits was built into the design of the study. How so? The study allowed subjects who’d had ECT before, as recently as two months prior, to be counted as the “before ECT” patients–meaning before this course of ECT. It assumed that any effects of ECT resolve within two months. 43% of the subjects had had prior ECT, so that at least half of the data involved comparing the effects of ECT to the effects of more ECT–not isolating the effects of ECT.

2) The outcome measures used to measure amnesia and cognitive function are irrelevant and inadequate to measure the known effects of ECT. Yet even deliberately using measures that would result in underestimating deficits, these deficits were still found to be profound and persistent!

For a critique of the tests used by Sackeim, see Robertson and Pryor’s article, Memory and cognitive effects of ECT: informing and assessing patients, in Advances in Psychiatric Treatment (2006), vol. 12, p. 228-238. For example, the Mini Mental Status exam used by Sackeim is a test that screens for dementia, the grossest and most glaring form of cognitive disability, and is useless for detecting the kinds of deficits caused by ECT.

Sackeim uses a memory test he invented himself, the Autobiographical Memory Inventory. This test is unpublished, not publicly available, not validated, and is not used except by ECT advocates. Robertson and Pryor note that the majority of questions are not relevant to the types of information forgotten by ECT survivors, nor can the test detect amnesia beyond a one-year period. A string of references in Sackeim’s new article attempt to provide support for the claim that the AMI “has shown strong reliability and validity as a measure of retrograde amnesia.” Not only do they not show this, but all the referenced articles were written by Sackeim himself!

3) Patient IQs were estimated pre-ECT using a method that underestimates intellectual ability especially with much higher than average IQs; no attempt was made to ascertain actual IQ. No one looked at these patients’ IQs post-shock to see what happened to them; why not?

Sackeim et al. conclude, based on inaccurate assumptions and no data from these or any other patients, that “Individuals with greater premorbid abilities can better compensate for the impact of ECT on cognitive functions” (references claiming to support this point have nothing to do with ECT but are articles about an unproven theory of “cognitive reserve”).

Even if the researchers didn’t choose to seek out survivors of ECT who once had very high IQs, or to respond to the many survivors of formerly superior IQs who have contacted them, there is a substantial record of accounts by persons who had extremely high or genius IQs who have spoken and written publicly of the devastating effects of having those IQs lowered by ECT (Jonathan Cott, Linda Andre, Anne Donahue, and Marilyn Rice are four such individuals.) None of these accounts suggests that people with “greater premorbid abilities” have an easier time after ECT; in fact, they strongly suggest the opposite.

In addition to these tricks, the researchers used one of the most reliable methods of biasing results: concealing data.

1) “A substantial number of secondary cognitive measures” are said to have been administered along with the named tests, yet the researchers nowhere reveal what they were and what the results were.

2) The names of the seven facilities in the New York City metropolitan area are not revealed. While this isn’t necessary for evaluating the results of the study, it means the facilities with the worst outcomes can’t be held publicly accountable, nor can the millions of city residents protect themselves from the worst offenders.

3) The results of the cognitive tests on the 24 control subjects are not revealed, nor is how they compared to the people who had ECT.

It’s a very big deal for the Sackeim team to use matched normal controls; in 25 years and hundreds of studies they have not done so. Normal controls are essential to ethical and valid research. This article states that “The comparison sample completed the same neuropsychological battery at time points corresponding to the assessment period in patients.” But you search in vain to find out how the controls did on the five named tests of memory and cognitive functioning and the unnamed “secondary measures”, and how they compared to the ECT patients immediately and six months after ECT. It’s not in the text, and it’s not in the tables. So why have the controls take the tests at all, if you’re not going to reveal the results?

Only one thing is revealed: The normal controls did much better than the bilateral ECT patients on the (flawed) measure of amnesia:

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

4) Sackeim does not reveal—has never revealed in hundreds of published articles—his financial ties to the shock machine companies Mecta and Somatics. Yet in sworn testimony, Sackeim admits he has worked for Mecta for at least twenty years. He designs their shock machines for them. Not only is disclosure required by journals such as Neuropsychopharmacology (ironically, the subject of a recent scandal in which authors and even the journal’s editor did not reveal their ties to another company which has hired Sackeim, Cyberonics), it is also required by state law (because Sackeim is an employee of New York State) and federal law (because Sackeim accepts NIMH money).
Sackeim flaunts these laws by not disclosing the money he makes from the shock machine manufacturers.

This article is a damning critique of work done over 25 years (and at the expense of millions of taxpayer dollars) by this very team of researchers.

If you know that Sackeim’s been funded for decades to do this research and chose not to do it, the following statements read very differently than the researchers intended. Instead of self-congratulation, they read as condemnation.

“Empirical information about ECT’s long-term effects derives mainly from small sample studies conducted in research settings, with follow-up intervals limited to two months or less…These studies could not adequately assess the severity and persistence of long-term deficits.”

The use of small samples and short-term follow-up characterizes all of Sackeim’s work until now, and was their choice, deliberately made so as not to know (officially) about “the severity and persistence of long-term deficits.” These researchers single-handedly had the wherewithal to address these belatedly-acknowledged flaws in their own research at any time since 1981.

“We conducted the first large-scale, prospective study of cognitive outcomes following ECT.”

Why the first study only after 25 years? What of the generation of patients—two and a half million people according to their own estimate—who have received shock in those years without knowing the long-term consequences?

“Severity of depressive symptoms showed little relationship with the cognitive measures. At the post-ECT time point, none of the 11 measures were related to concurrent HRSD scores. Findings were also negative for 8 of the 11 measures at the six-month follow-up.”

Translation: patients aren’t just imagining or lying about their cognitive and memory deficits because they’re crazy. Yet in many published articles written on the NIMH dime, and over and over in public testimony and in court, that is exactly what Sackeim and Prudic have claimed. And they have influenced countless others to believe it.

DAMNING FINDING #1: amnesia is substantial and permanent

“The average decrement in AMI-SF scores in patients treated exclusively with BL ECT was 3.4 and 2.8 times the amount of forgetting seen in the healthy comparison groups at the post-ECT and 6-month time periods, respectively, suggesting that the deficits were substantial.”

“At the six-month time point, there continued to be a significant relationship between the number of BL ECT treatments and the extent of retrograde amnesia.”

“Greater amnesia for autobiographical events was significantly correlated with the number of ECT treatments received 6 months earlier.”

DAMNING FINDING #2: cognitive deficits are substantial and permanent

“Compared to baseline performance, at the postECT time point the total patient sample showed deficits in the mMMS, sensitivity of the CPT, delayed recall of the BSRT, delayed reproduction on the CFT…” (All are measures of memory and cognitive ability).

“This study provides the first evidence in a large, prospective sample that the adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”

DAMNING FINDING #3: ECT permanently affects reaction time

“Although psychomotor function is of practical importance with respect to driving and other motor activities, the impact of ECT on this domain has rarely been examined…”

(Once again: Whose fault is that?)

“The fact that relative reaction time deficits were observed at the 6-month follow-up indicates a persistent change in the speed of information processing, motor initiation, or response levels…The findings here raise the concern that this form of stimulation has deleterious long-term effects of elemental aspects of motor performance or information processing.”

DAMNING FINDING #4: Bilateral ECT is no good

“For decades, BL ECT represented the gold standard with respect to ECT efficacy…A majority (of US ECT practitioners) administer mainly or exclusively BL ECT…
There appears to be little justification for the continued first-line use of BL ECT in the treatment of major depression.”

(More than 90% of the ECT given in the U.S., and at least as high a proportion in other countries, is bilateral.)

DAMNING FINDING #5 They lied when they wrote in the APA consent form that ECT improves your memory

What this team has said in numerous published articles—and what Sackeim wrote into the American Psychiatric Association guidelines on ECT, the “bible” used by all rank and file shock doctors—that ECT improves memory and intelligence, is not true.

“It is noteworthy that most cognitive parameters were substantially improved at 6-month follow-up relative to pre-ECT baseline, presumably because of the negative impact of the depressed state on baseline performance…It cannot be concluded, however, that the extent of improvement in any group returned to premorbid levels.”

DAMNING FINDING #6: A much greater percentage of women than men are damaged by ECT than men: 81% vs. 18%.

“There was a gender difference, with a greater preponderance of women (81.6%) compared to men (18.4%) in the persistent deficit group.”

No doubt Sackeim and his handlers will try to “spin” this study as a scientific breakthrough, and hold him up as a reformer and patient advocate. Nothing could be farther from the truth.

Where is the apology to the generation of people who were lied to, who will never regain their memories and their cognitive abilities?

Full study

Al Siebert on MindFreedom Radio Wednesday

MindFreedom UPDATE — 21 November 2006
Nonviolent Revolution in Mental Health Care – please forward

*Tomorrow* Wednesday, 22 November 2006 – MindFreedom News Hour Free Internet Radio

Guest is Al Siebert, psychiatric-survivor psychologist-author

To listen live click on at 4 pm EST, 1 pm PST tomorrow Wednesday, 22 Nov. 2006, or listen to the archive later. Yes, the archives now work!

You may phone in to the show live toll free with your questions or comments, or e-mail them to

Host of the show — which begins and ends with news and resources about changing the mental health system — is David Oaks, psychiatric survivor, human rights activist for 30 years, and director of MindFreedom International.


Al Siebert short bio:

Al Siebert received his M.A. and PhD. in clinical psychology from the University of Michigan. Al is a psychiatric survivor and calls his story the “Marvelous Menninger Adventure.” He has been a strong advocate for the human rights of people who considered to be “mental patients” for many years.

Dr. Siebert:

** is author of professional journal articles about the ways that psychiatry misrepresents what is known about “schizophrenia.”

** is project director of the “Weller Than Well” research project searching for people made stronger by their so-called “psychotic” experiences.

** serves on Advisory Council for International Center for the Study of Psychiatry and Psychology, founded by Peter Breggin.

** hosts the popular Successful Schizophrenia website.

** is author of A SCHIZOPHRENIA BREAKTHROUGH: Progress Toward Freeing Our Minds from Our Minds. A textbook for graduate students with “Issues for Critical Thinking and Research.” Foreword by William Glasser, M.D.

In addition to the above, Dr. Siebert is internationally recognized for his research into the inner nature of highly resilient survivors. His most recent book, The Resiliency Advantage, is winner of the “2006 Best Self-Help Book” award.

More info on Al’s projects and books see


More info on MindFreedom see


Next week, Wed. 29 November 2006 — Leah Harris, psychiatric survivor activist and on the board of National Association for Rights Protection and Advocacy. Leah calls for greater involvement of youth, and dedication to youth issues.


Announcing: MindFreedom totally redesigned web site is now up at We are finishing a few last minute touches but feel free to drop by for a preview and spread the word.


Join MindFreedom International, donate, or renew your membership.

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You are not alone! MindFreedom is a nonprofit human rights group that unites 100 sponsor and affiliate groups with individual members, and is accredited by the United Nations as a Non-Governmental Organization (NGO) with Consultative Roster Status. Join or donate today!

MindFreedom is one of the very few totally independent groups in the mental health field with no funding from governments, drug companies, religions, corporations, or the mental health system. While most of MindFreedom’s members are psychiatric survivors, *all* who support human rights are invited to join and become active leaders.

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Please forward.

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Psychiatrist defends electric shock treatment in NSW

ABC News (Australia)
Nov 18 2006

The chief psychiatrist in New South Wales has defended the use of electric shock therapy in the state’s hospitals.

Government figures show the use of electric shock therapy has doubled in NSW in the past decade and more than a dozen children under the age of 14 have been given the treatment.

But Associate Professor John Basson says the perceived increase is not accurate because records of electric shock therapy were not reliable a decade ago and did not reflect the true number of cases.

He says there is no recorded cases of children receiving the treatment in the past two years, but his colleagues would not support a ban on the practice.

“Across the board they wouldn’t wish to lose it as a possible treatment in very, very rare and unusual cases where the life of the child was put at risk,” he said.

“This would be a treatment of extremely last resort.

“Recently we’ve been very much more scrupulous and that plays a part.

“You’ve got to be careful that we’re not comparing apples with oranges. We’ve got to compare apples with apples and we are now in a situation where we can compare.

“I don’t see that sort of increase that would cause us concern or would cause us to question.”

Australia: Use of electric shock therapy has doubled in decade

By Clare Masters

November 18, 2006
The Daily Telegraph

CONTROVERSIAL electric shock treatment is making a comeback in NSW hospitals, with new figures showing the use has doubled in the past 10 years, including on schoolchildren.

Federal Government statistics show the use of Electro Convulsive Therapy (ECT) – electric shock delivered to the brain – has risen in the state from 2093 in 1994-1995 to 5291 in 2005-2006.

The Medicare statistics recorded 16 cases in the five to 14 age bracket.

The figures come as the Western Australian Government bans ECT for children under the age of 12, but the NSW Government has ruled out prohibiting the treatment for children.

“NSW Health is not aware of any child under 12 years having received ECT in the public hospital system in recent years,” a spokeswoman said.

The Royal Australian and New Zealand College of Psychiatrists Dr Phil Brock said the college did not recommend the use of ECT on children due to their developing brains.

Sydney University’s Professor of Child and Adolescent Psychiatry Garry Walter said he was unaware of any cases in NSW relating to very young children but said it was possible in 15 year olds.

“It is rare but when it is used it can be lifesaving – its use is most common in young people with severe mood disorders,” he said.

Notorious for its barbaric use in Sydney’s Chelmsford Private Psychiatric Hospital, shut down nearly 30 years ago, ECT is increasingly used across the country – up from 9034 in 1994-1995 to 18,083 in 2005-2006.

Although doctors are still mystified as to how the therapy works, it is used to treat mental disorders such as depression and psychosis.

Adverse reports of ECT include memory loss, spontaneous seizures and headaches and modern treatment involves administering, under anaesthetic, a series of electric shocks to the brain at intervals over a few weeks.

Reports on Australian mental health support website record one person claiming the treatment was “humane” and “changed my life”.

Another 54-year-old male said he suffered short-term memory loss and headaches and a 43-year-old male reported forgetting his phone number.

“I will never voluntarily have ECT again,” he wrote.